ABSTRACT
Introduction
The introduction of Single-Port (SP) platform opened the field to new surgical options, allowing to perform major urological robot-assisted procedures extraperitoneally and with a supine patient positioning (1–3). Nevertheless, a comprehensive description of different supine access options is still lacking (4–6). In this light, we provided a step-by-step guide of SP extraperitoneal supine access options also exploring preliminary surgical outcomes.
Materials and methods
Transvesical access was performed by a transversal incision 3cm above the pubic bone, after the anterior abdominal sheet incision, the bladder was insufflated with a flexible cystoscope and the detrusor muscle was incised at the level of the bladder dome. Similarly, the extraperitoneal access was carried out with a 4cm incision above the pubic bone, once visualized the preperitoneal space the prevesical fat was gently spread. The Low Anterior Access was performed with a 3cm incision at the McBurney point, the abdominal muscles were then spread. A gentle dissection was used laterally to develop the retroperitoneal space.
Results
Overall, sixteen different procedures were performed with supine extraperitoneal access on 623 consecutive patients. No intraoperative conversions occurred. The median access time was 16 (IQR 12-21), 11 (IQR 7-14) and 14 (IQR 10-18) minutes in case of transvesical, extraperitoneal and low anterior access, respectively. Notably, 81.5 % of patients were discharged on the same day with a postoperative opioid free rate of 73%.
Conclusion
The Atlas provides a comprehensive step-by-step guide to successfully perform all major urological SP procedures extraperitoneally and with supine patient positioning.
Available at: http://www.intbrazjurol.com.br/video-section/20240400_Lambertini_et_al
REFERENCES
- 1.Soputro NA, Kaouk J. Single-port robot-assisted radical prostatectomy. World J Urol. 2024;42:245–245. doi: 10.1007/s00345-024-04914-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Cannoletta D, Pellegrino A, Pettenuzzo G, Pacini M, Sauer RC, Torres-Anguiano JR, et al. Single-Port Transvesical Vesico-Vaginal Fistula Repair: An Initial Experience. Int Braz J Urol. 2024;50:502–503. doi: 10.1590/S1677-5538.IBJU.2024.0146. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Pellegrino AA, Chen G, Morgantini L, Calvo RS, Crivellaro S. Simplifying Retroperitoneal Robotic Single-port Surgery: Novel Supine Anterior Retroperitoneal Access. Eur Urol. 2023;84:223–228. doi: 10.1016/j.eururo.2023.05.006. [DOI] [PubMed] [Google Scholar]
- 4.Moschovas MC, Brady I, Noel J, Zeinab MA, Kaviani A, Kaouk J, et al. Contemporary techniques of da Vinci SP radical prostatectomy: multicentric collaboration and expert opinion. Int Braz J Urol. 2022;48:696–705. doi: 10.1590/S1677-5538.IBJU.2022.99.16. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Flammia RS, Anceschi U, Tuderti G, Di Maida F, Grosso AA, Lambertini L, et al. Development and internal validation of a nomogram predicting 3-year chronic kidney disease upstaging following robot-assisted partial nephrectomy. Int Urol Nephrol. 2024;56:913–921. doi: 10.1007/s11255-023-03832-6. [DOI] [PubMed] [Google Scholar]
- 6.Ditonno F, Franco A, Licari LC, Bologna E, Manfredi C, Katz DO, et al. Implementation of single-port robotic urologic surgery: experience at a large academic center. J Robot Surg. 2024;18:119–119. doi: 10.1007/s11701-024-01884-z. [DOI] [PubMed] [Google Scholar]